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Exam of the cardiovascular system Flashcards

(58 cards)

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1
Q

Detailed exam of the cardiovasc system: order

A

Heart
Blood vessles: arterial, venous, capillary
Blood: mucous membranes, anemia, polycythaemia, dehydration

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2
Q

Physical exam:

A

Inspection (heart and vessels)
Palpation (heart and vessels)
Percussion (heart)
Auscultation (heart)

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3
Q

Inspection of the heart

A

Abnormalities of the thorax e.g injury or malformation
Heart beat- the apex beat in cat and dog
-it’s location and possible dislocation
-intensity/strength and if it is increased or decreased

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4
Q

Palpation of the heart

A

To detect pain
Location of the heart beat- diclocation can be caused by e.g tumour, abscess or pneumothorax
Strength/intensity of heart beat
-increased: exercise, cardiac hypertrophy
-decreased: heart disease, fluid, thickened chest wall
To detect fremitus which can be endo, peri or extra pericardial (the endo is caused by turbulent flow of blood)

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5
Q

Percussion of the heart

A 
Primary goal in smalls is to detect:
- fluid accumulation
-space occupying lesions 
-PTX
To locate the area of cardiac dullness- absolute or relative
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6
Q

Causes of alterations in the area of cardiac dullness

A

Enlargement of cardiac dullness is when dullness is detected in the lower part of the chest
Dilation, hypertrophy
Pericardial effusion
Cardiac dislocation
False enlargement: other organs or space occupying lesions e.g tumour, abscess, hernia
Fluid accumulation- causes a horizontal line of dullness and the Diernhofer triangle disappears

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7
Q

Auscultation of the heart

A

Maximum audibility of the valves
1-4 normal heart sounds
Alterations of the heart sounds: FRIDA
frequency, rhythm, intensity, demarcation, additional

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8
Q

FRIDA: Frequency

A

Coincides with pulse
Starts in aorta coincides with closing of the valves
Pulse deficit is always patho!
Exam: simultaneous ausc and palpation of pulse
Normal values are different depending on species
Changes: tachy or bradycard

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9
Q

FRIDA: rhythm

A

Normally regular

Arrhythmia is patho and is usually accompanied by pulse deficit

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10
Q

FRIDA: intensity

A

Normally uniformly strong and even
Pounding: increasing over first and second sounds
Reduced heart sounds means decreased CO- can be caused by pericardial/pleural effusion or obesity

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11
Q

FRIDA: demarcation

A

Distinctness of the cardiac sounds
Smalls- the 1 and 2 sounds are the most pronounced
Patho: gallop sounds (cardiomyopathy) where 3 can be heard: either 1,2,3 or 4,1,2
Splitting of heart sounds e.g in the 2nd heart sound closure of the aortic and pulmonary valves at different times- can be caused by cor pulmonale

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12
Q

FRIDA: additional sounds

A

MURMURS!!!

Endocardial or extracardiac

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13
Q

Endocardial murmurs

A

Caused by turbulence

  1. Location: points of maximal intensity
  2. Relation to phase of cardiac cycle: systolic or diastolic
  3. Frequency/pitch
  4. Character/quality/shape: continuous, crescendo, decrescendo
  5. Conduction

Morphological: valve, septal, vessel
Functional: innocent murmurs, anaemia causing decreased blood viscosity

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14
Q

Extracardiac murmurs

A

Pericardial or pleuro-pericardial or pleuro-pleural
VARIABLE! location and intensity can be heard during different phases of the cardiac cycle
Extremely rare in smalls

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15
Q

Further/ additional exams

A

Radiography
Echocardiography
US

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16
Q

What can thoracic radiography diagnose

A

Cardiac enlargement
Pulm edema
Extracardiac diseases

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17
Q

How US pictures are formed

A

Sound waves encounter tissues of different densities, sound wave is reflected back to probe and is detected as an echo
When the sound waves penetrate fluid, no echos will be reflected from it and the area appears black in the image

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18
Q

Acoustic impendance

A

Constant value for material in question

Calculated based on density and the acoustic speed of US within the material

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19
Q

Technique of US

A

Transducer can be linear or sector with the necessary frequency
Linear: in a row- supf organs e.g tendons
Sector: cone shaped, smaller contact surface- deeper organs

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20
Q

For echocardiography

A

SECTOR transducers only- needs to fit btw ribs

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21
Q

Diagnostic possibilities of US and echocardiography

A

Exam of the cardiac chambers
Valvular disorders
Contrast echocardiography- shunts, septal defects
Doppler echocardiography- blood flow disorders

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22
Q

Technique for echocardiography

A

Lateral recumbency

Exam from the right hemithorax

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23
Q

Views for echocardiography

A

Right parasternal transducer view

  • long-axis plane gives 4 chamber view
  • short-axis plane changes the angle 90 degress and gives a cross-sectional view of the heart

Quantitative
-gives the left atrial to aortic ratio which is very important to assess left heart failure and severity

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24
Q

What can be diagnosed specifically with echocardiography

Study These Flashcards
A

Dilated cardiomyopathy– dogs
Hypertrophic cardiomyopathy– cats
Pericardial fluid and mass

25
ECG, what is it?
Measures amplitude and time of potential differences of electrical current generated through depolarization and repolarization of cardiac structures
26
Principles of the ECG
Intracardial- invasive and obsolete Epicardial Measurement on surface of body Voltage measured with height of wave- the positivity or negativity of wave is determined by the positioning of the electrodes and the main direction of the electric axis in the heart
27
Einthoven ECG- triangle measurement
Electodes on 3 limbs: negative to right arm, positive to left hind
28
Interpretation of the waves
P-wave: SA depolarization Q-wave: potential is travelling in the pukinje fibers- small negative wave R-wave: ventricular depol S-wave: repolarization of base of heart- small negative wave T-wave: end of ventricular repolarization
29
Goldberg vs Einthoven ECG
Goldberg: measurement btw one point and the average of the other 2 30 degree angles therefore more precise Einthoven- P waves are not always visible!!
30
Artefacts of an ECG
Movement- sometimes not all leads are affected Electrical- 50Hz interference from the 'normal' electricity in power outlets Electrode reversal- wrong placement
31
Indications for ECG?
The main ones: Arrhythmia, tachycardia, bradycardia Monitoring anaesthesia Others: Effect of cardiac or cardiotoxic drugs Cardiac effects of electrolyte distrubances Enlargement of cardiac chambers
32
First steps in ECG analysis?
Check the quality i.e if there are artefacts Check if there is electrode reversal Are the P-waves visible?- if not increase speed or use chest leads or modified limb leads Recognise and name the waves Determine the heart rate- count the QRS complexes Measure distance btw 2 beats i.e the RR distance
33
Morphology of ECG waves
``` Segment= distance without the wave Interval= includes the wave P-wave: atrial depolaeization QRS: ventricular depol Size of the R and P wave: magnitude of depolarization, measured from the baseline PQ: beginning of depol in sinus node to reaching the ventricle QT: time for ventric depol ST segment: almost flat ```
34
Examination of the blood vessels: arterial system
Digital palpation, pulse pressure- PULSE Blood pressure measurement- direct or indirect- sphygmomanometry Blood flow registration- Doppler US Pulse wave velocity
35
Pulse quality
Depends on size | Difference btw systolic and diastolic BP is pulse pressure
36
What is systemic arterial BP
CO x total peripheral resistance
37
Factors determining CO and TPR
``` Heart rate Ejection volume -circulating blood -heart contraction -integrity of cardiac structures ``` Total peripheral resistance - vessel diameter: small vessels - elasticity of the vessels: large - blood viscosity: PCV
38
Parameters to measure when taking the pulse
Frequency Rhythm Quality- ...size, compressibility(strength) and duration of the pulse waves
39
Abnormal findings of the pulse quality
Irregular Uneven Size: when large is hyperkinetic, small is hypokinetic Compressibility: hard has to do with cardiac function, soft has to do with vascular tone
40
Examination of the venous system
Inspection Palpation Measurement of central venous P Examine the jugular vein
41
Venous system: parameters
Degree of fullness- venous stasis compression test | Movement within veins
42
Physio movements within the vein
Resp, diastolic, false (carotis pulse) Max at ventral 1/3 of neck Disappears with compression test
43
Patho vein pulse
Systolic Pronounced over the ventral 1/3 of neck Persists after compression test
44
Congested jugular vein
ALWAYS patho!!
45
Blood pressure measurement: central venous pressure
``` Direct: catherization- Indirect: -examination of peripheral veins -hepatojugular reflux test -dogs: collapse of v. saphena during lifting of hindlimb in lateral recumbent position ```
46
Exam of the capillary system
Exam of the mucus membranes Colour CRT Fullness of caps Livid- empty Light red- increased fullness of arterioles Violet- congestion
47
Systemic arterial pressure
Need to understand that blood pressure is not equal to pulse pressure, blood pressure cannot be examined by palpation
48
How to calculate systolic-diastolic values
Pulse pressure= systolic pressure minus diastolic pressure
49
How to calculate mean arterial pressure (MAP)
Diastolic pressure+pulse pressure | divided by 3
50
Blood pressure depends on...
``` Anatomical place- the arterial tree Body position Heart rate Blood pressure itself SAP more affected than DAP or MAP ```
51
Indications for measuring blood pressure
To reveal secondary hypertension in case of known predisposing diseases Search for cause of target organ damage To monitor the effect of BP lowering drugs In shock- to avoid hypotension Monitor anaesthesia- to avoid hypotension
52
Causes of hypertension
``` Situational, stress induced Measurement error Kidney diseases Adrenal gland e.g Cushing's Hyperthyroidism ```
53
Conseqeunces of hypertension- target organ damage
Eye- cornea and retinopathy, maybe permanent blindness Brain Heart Kidney- proteinuria Most often no clinical signs
54
Methods of measuring blood pressure
Direct/invasive: arterial cannulation! but this is painful and sedation is required Indirect/non-invasive: Doppler, oscillometry
55
General technique for measuring the blood pressure
Calm environment, acclimatization Take mean of 3-5 measurements If very high- has to be repeated at least 30 mins later Cuff-size is 30-40% limb or tail circumference -if too big the measurement is higher!
56
Doppler method
Better in cats vs dogs
57
Oscillometry
Determination of the mean arterial pressure (MAP) | Use the a. caud. med on the tail but if the tail is not possible use the FL a. brachialis
58
Additional tests
``` Blood tests: ANP, BNP, troponin, endothelin Phonocardiography (PCG) Non-selective angiocardiography Cardiac catherization Radionuclide imaging Serology for e.g Lyme ```

SAM (16 decks)

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